膨体聚四氟乙烯额肌悬吊术治疗儿童先天性上睑下垂的临床疗效和安全性评价  

Effectiveness and safety of expanded polytetrafluoroethylene-assisted frontalis suspension for pediatric congenital ptosis

作　　者：吴倩[1] 胡守龙[1] 刘雯[1] 樊云葳[1] 曹文红[1] 王媛[1] 蔺琪[1] 张诚玥[1] 于刚[1] 

机构地区：[1]首都医科大学附属北京儿童医院儿科学国家重点实验室,北京100045

出　　处：《中华实验眼科杂志》2016年第11期997-1001,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景 先天性上睑下垂是一种易引起弱视的儿童眼病,及时进行手术并寻找理想的额肌悬吊材料具有非常重要的意义.目前国际上常采用膨体聚四氟乙烯（e-PTFE）材料作为额肌悬吊材料对低龄儿童的先天性上睑下垂进行治疗,取得了较好的效果,但中国尚缺乏相关的临床资料. 目的 应用e-PTFE材料进行额肌悬吊术治疗先天性上睑下垂儿童,观察其临床治疗效果及其安全性,评价其临床应用价值.方法 采用前瞻性系列病例观察性研究方法,收集2012年7月-2012年8月在北京儿童医院确诊的年龄为2.8 -6岁的先天性上睑下垂患者36例45眼,所有患儿均行额肌悬吊术,术中采用e-PTFE为额肌悬吊材料.分别于术后1d、1周、1个月、3个月、6个月、1年、1.5年进行复查,观察指标包括上睑缘至角膜光反射点距离（MRD）、睑裂高度、额肌与睑板关联度、眼睑闭合情况以及上睑迟落情况、术后外观评分,记录术后复发率和相关并发症及其处理结果. 结果 术后1.5年患儿的MRD为（2.8±0.8） mm,明显高于术前的（1.8±1.2）mm,差异均有统计学意义（t=4.651,P=0.000）;术后眼睑闭合度为（1.3±0.5） mm,与术前的（1.1±0.5） mm比较差异无统计学意义（t=1.897,P=0.061）;术后额肌与睑板关联度为75％±20％;术后外观改善满意.本组患者中术后1例1眼欠矫,出现轻度角膜炎者1例1眼,角膜炎患儿系术后护理不当,经指导家长术后正确点用上皮生长因子联合玻璃酸钠滴眼液后痊愈;术后发现额部伤口肉芽肿1例1眼,局麻下将肉芽肿切除,局部注射地塞米松注射液0.2ml,1个月后无复发;眼睑内翻1例1眼,考虑与术中上睑位置过高有关,经观察于术后3个月上睑位置部分地回落,上睑内翻自愈;术后3个月16例20眼可在额部切口缝合部位局部触及皮下小硬结,至随访末自行消失.复发1例1眼,经二次手术治愈.结论 e-PTFE作为额肌悬吊材料对于先�Background Congenital ptosis is a common eye disease of children that easy cause amblyopia.Searching for an ideal frontalis suspension material is very important for the timely treatment of ptosis.Expanded polytetrafluoroethylene （e-PTFE）,a new frontalis suspension material,has been widely applicated abroad to correct the congenital ptosis,but the clinical data of e-PTFE use in congenital ptosis is lack.Objective This study was to evaluate the efficacy and safety of e-PTFE patch as sling material in frontalis suspension surgery for congenital ptosis of children.Methods A prospective serial cases-observational study was conducted.Forty-five eyes of 36 children with congenital ptosis enrolled in Beijing Children＇s Hospital from July to August 2012 with the age of 2.8-6.0 years.All the children received e-PTFE-frontalis sling surgery after their custodians signed the informed consent.The margin-reflex distance （MRD） upper eyelids,width of palpebral fissure,linkage between the frontalis muscle and the upper eyelid,catamysis,upper eyelid late drop,appearance score,recurrence rate and postoperative complications were evaluated 1 day,1 week,1 month,3 months,6 months and 1 year,1.5 years after surgery.Results The mean M RD was （1.8 ± 1.2） mm and （2.8 s0.8） mm before surgery and 1.5 years after surgery,respectively,showing a significant difference between them （t =4.651,P =0.000）.The catamysis was （1.3 ± 0.5） mm and （1.1 ± 0.5） mm before surgery and 1.5 years after surgery,respectively,and there was not significant difference between them （t =1.897,P =0.061）.The linkage between the frontalis muscle and the upper eyelid after surgery was 75% ±20%,and e-PTFE achieved a satisfied stable ptosis correction and approving appearance.Ptosis recurrence was noticed in 1 case;The complications included low-correction in 1 eye of 1 patient,slight ceratitis in 1 eye of 1 patient,entropion in 1 eye of 1 patient,granuloma in 1 eye of 1 patient and subcutaneous nodule in 20 eyes of 16 patients,and th

关 键 词：眼睑下垂/先天性 眼睑下垂/手术 眼睑整容术/方法 假体植入 膨体聚四氟乙烯 儿童 疗效 额肌悬吊术 

分 类 号：R779.6[医药卫生—眼科]